Can Insurance Company Will Pay The Amount Or File An Appeal?

We have filed a case against the medical claim rejection by the insurance company on the basis of non-disclosure of pre-existing diseases, now District court has given order to the insurance company to pay the claim amount to us. Can an insurance company will pay the amount or they can appeal against the district court.

Answer (1)

Aayushi Sang

  • Sector-1, Noida

If you have claims settlement dispute with your life or health insurance company, you can approach the insurance ombudsman for resolution. Neither do the complainants have to pay any fee to the ombudsman to file a complaint nor do they have to hire a lawyer to represent their case.

Moreover, the ombudsman is required to pass an order (in favour or against the complainant) within 90 days of the complaint being received. Typically, the ombudsman comes to a decision in one or two hearings, unlike court cases where several rounds of hearing may take place before a decision is awarded.

While the award given by an ombudsman is binding on insurers, it is not binding on the policyholders. Appeal process The insurance ombudsman mechanism had been set up by the insurers themselves, as an alternative dispute redressal system.

It is a quasi-judicial body, established to address the grievances of customers, without them having to involve themselves in lengthy court proceedings. The ombudsman deals with various types of complaints, but most are usually related to claim disputes. The ombudsman can deal with disputes where the maximum amount of claim is less than Rs.20 lakh.

For more clarification, you can consult our experienced insurance lawyer in India who will guide you in your matter.

Answered on 02 Aug 2019


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